The medical insurance pooling account will not be exhausted.

Medical insurance pooling refers to the remaining portion of the medical insurance premiums paid by all employers in a certain pooling area for their employees after deducting them and transferring them to individual accounts.

The medical insurance overall fund belongs to all insured persons, is centrally managed by social insurance agencies, and is uniformly allocated and used. It is mainly used to pay medical expenses, surgical expenses, nursing expenses, basic examination fees, etc. incurred by insured employees.

The medical insurance pooling fund shall be stored and used exclusively for special purposes, and shall not be misappropriated by any unit or individual.

The details of medical insurance pooling risk prevention are as follows: (1) It is necessary to increase collection efforts and ensure the fund collection rate.

To ensure the normal operation of the overall fund, it is necessary to ensure a high fund collection rate and pay attention to preventing malicious defaults; (2) Establish and improve the basic medical insurance budget system and fund early warning system.

The fund early warning system refers to setting corresponding warning lines for various funds through the management information system when establishing the basic medical insurance system, so as to warn in advance of possible risks in the operation of the fund system; (3) It is necessary to determine the appropriateness based on actual conditions.

payment ratio.

Because income levels, medical consumption levels, etc. vary greatly across regions, the principles of seeking truth from facts, adapting measures to local conditions, and analyzing specific issues must be adhered to in terms of payment ratios and payment methods; (4) An adjustment and balancing mechanism for overall fund payment must be established.

The overall fund mainly pays most of the hospitalization expenses of medical insurance patients and part of the expenses of special outpatients. Usually, hospitalization expenses are paid in installments according to a certain proportion, while payment for special outpatients varies from place to place. Outpatient subsidies for special diseases should adopt a flexible proportion.

, that is, the specific proportion of subsidies should be determined based on the balance of the year-end overall fund; (5) Strict review of serious illnesses.

The threshold setting and payment ratio for critical illness mutual aid are different, and the cost increases significantly, which puts considerable payment pressure on medical insurance agencies.

Article 28 of the Social Insurance Law of the People's Republic of China. Medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue expenses shall be paid from the basic medical insurance fund in accordance with national regulations.